“Now they just say it will get better on its own.”: a qualitative exploration of discontinuation of facility-based tele-mental health services in Bangladesh

AI Summary

Perceived recovery and perceived lack of benefit both prompted disengagement, reflecting shifting expectations of tele-mental health treatment.
Everyday constraints, including fluctuating mental wellbeing, competing life demands, distance and provider communication gaps, disrupted continuity of care.
Limited family support and motivation reduced sustained engagement; services should emphasise continuous engagement, clearer treatment pathways and active family involvement.

BMC Health Serv Res. 2026 Jul 18. doi: 10.1186/s12913-026-15109-6. Online ahead of print.

ABSTRACT

BACKGROUND: Discontinuation of mental health care is a persistent global challenge, with up to one-third of patients dropping out before treatment completion. Evidence on discontinuation from facility-based tele-mental health services in low- and middle-income countries remains limited. This study explores why patients disengage from facility-based tele-mental health services delivered through Wellbeing Centres in Bangladesh.

METHOD: A qualitative study was conducted between October 2024 and February 2025 using mobile phone interviews. Participants were service recipients who had discontinued follow-up services provided by the Wellbeing Centres. A total of 26 interviews were conducted, and the data were analyzed thematically.

RESULTS: Discontinuation was shaped by dynamic and sometimes contradictory patient experiences. First, perceptions of treatment outcomes influenced disengagement in complex ways: both perceived improvement and perceived lack of benefit led to discontinuation, reflecting shifting expectations of care. Second, everyday constraints-including fluctuations in mental wellbeing, competing life demands, distance from facilities, and communication gaps with providers-disrupted continuity of care. Third, family dynamics played a critical role, with limited support and motivation reducing sustained engagement with services.

CONCLUSION: Discontinuation from facility-based tele-mental health services is not solely driven by access barriers but emerges from the interaction between perceived recovery, unmet expectations, and socio-cultural influences, particularly family involvement. Interventions should move beyond access-focused models to incorporate continuous patient engagement, clearer communication of treatment pathways, and active involvement of family members. These findings have implications for the design and scale-up of facility-based tele-mental health services in low- and middle- income countries (LMICs).

PMID:42471658 | DOI:10.1186/s12913-026-15109-6

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